The Metropolitan police have ordered officers not to respond to calls from mental health units and emergency departments for help to control and restrain patients unless there is a "significant threat to life or limb".
The police decision, seen within mental health units as a significant change in policy, has caused confusion, anger and concern among staff in psychiatric hospitals who fear that they and patients are being put at risk.
In a growing row over where to draw the lines between the responsibilities of the police and health bodies when dealing with violent disturbed people, senior managers in the NHS have told nursing staff within psychiatric units to record all incidents where they have called for help from the police but it has been refused.
They have also been told to note each occasion when staff are assaulted and the police either have not investigated or have decided to take no further action.
It is understood that some recent calls to police for help from hospital emergency departments have been refused as the new guidance takes hold in boroughs across London. Staff fear the lack of support could result in serious injury or death.
The Met has acted against a backdrop of growing concerns in the police service nationally about the impossible burden that responding to incidents involving mental health issues is placing on forces. The force is concerned that while staff in mental health facilities are specially trained to control and restrain psychiatric patients, the police are not.
Several Met officers are being investigated by the police watchdog and could face manslaughter charges following the death of Seni Lewis after a restraint by police who were called to the Maudsley hospital, in south London, in 2010. Lewis, a 23-year-old graduate, was restrained three times, first by hospital staff and then by Met officers, in the 45 minutes before he collapsed and died.
The new protocol was issued to borough commanders in the last eight weeks but not shared with local mental health units. It states:
• Transportation to a place of safety should be in the form of an ambulance and responsibility for transfers between psychiatric hospitals and to emergency departments rests with the hospital not the police.
• Police will not attend a health trust to assist in restraining patients receiving treatment or assessment.
• Police will not attend trust premises merely to restrain a patient located therein or to stand by and prevent a breach of the peace.
• Police will attend all premises in the event of a significant threat to life or limb that requires force necessary to regain control.
Chief Superintendent Chris Bourlet, of the Met's mental health team, said the protocol was an attempt to standardise responses across the capital. He admitted that it was causing concerns within mental health facilities but said the Met was working to address those worries.
"This is about making sure everyone knows where we stand. This is not about withdrawing service where it is appropriate, it is about defining who is responsible for what and where the line is," he said.
Bourlet said the Met policy was in line with the protocols issued nationally by the National Policing Improvement Agency (NPIA). But in key respects the Met policy appears to go further.
The NPIA recommends that while officers should not ordinarily be called to assist when a patient is displaying management problems, it is appropriate for officers to attend if there are insufficient numbers of trained staff in the unit, if a breach of the peace of a crime is anticipated and if it is an emergency and the individual has to be taken to a place of safety that is not the current facility.
Within mental health units in the capital – particularly those dealing with the most violent patients – the new policy has angered staff who are increasingly worried about their own safety. "The problem is the protocol is open to misinterpretation and staff may be left vulnerable to violence and abuse," said one source.
The withdrawal of transfers has already affected the ambulance service, it is understood. Recently ambulance staff were unable to safely transfer a disturbed patients from a magistrates court to a psychiatric unit because the police refused to carry out the secure transfer.
Theresa May, the home secretary, has made a commitment to sort out the enormous amount of police time spent dealing with mental health patients. She told the police superintendents conference last month she was working with Jeremy Hunt, the health secretary, to stop the police being "the first port of call". But there is anger within the police service that as yet nothing has been done to reduce the burden.
The Met police said in a statement: "The MPS is not changing guidance in relation to attending mental health settings, but clarifying and reinforcing existing guidance and boundaries between the MPS and health partners. The MPS is in discussion with London mental health chief executives through the London mental health partnership board and is working with mental health trusts and the NHS to improve the safety of staff and those with mental health needs."
A spokesman for NHS England said: "The Metropolitan police have been very clear that they are not withdrawing support from NHS patients or staff where there is criminal activity occurring, including assault or violence.
"However, they have reviewed and reiterated their policy surrounding requests for assistance in restraining or transferring patients within mental health units. We are working with our provider organisations and their staff to develop new ways of working without relying on police support."
